with Lisa Wessan, LICSW

On the “Myth of Closure,” Ambiguous Loss and Complicated Grief

by Lisa Wessan, LICSW on January 5, 2019

“Everyone experiences ambiguous loss if only from breaking up with someone, or having aging parents or kids leaving home. As we learn from the people who must cope with the more catastrophic situations of ambiguous loss, we learn how to tolerate the ambiguity in our more common losses in everyday life.”

– Pauline Boss, Ph.D.

In my immediate family, several of my nearest and dearest have battled with cancer over the years…both of my paternal grandparents, may they rest in peace, my dear first cousin Stephanie (may she live to be a super centenarian) and my delightful and fierce Aunt Yvette (known as “Auntie”), who is currently receiving hospice care. It has been a long and grueling journey with cancer for all my loved ones.

Sometimes I struggle with feeling powerless, and living so far away from my family in Sarasota, FL. When they lived in New York, it was so much easier to visit. Sadly, I can’t make frequent visits to Sarasota. The only “power” I do have is to send intentional healing and loving energy to my Auntie and family…and to practice radical acceptance so that I will function with some measure of inner peace here in my world.

For a while, my Auntie was in and out of the nursing home while she battled her cancer and other complications from treatment. Her life was severely compromised by her illness. As harsh as this has been is for her, since April 2015, I have also been witnessing how Auntie’s dying process is affecting everyone around her.

My cousins are fraught with anxiety and grief. Others are a hot mess, watching Auntie dying so slowly, not being able to process their feelings and find some relief. Some people get trapped in the “Blame Game,” and are always looking to find ways to defocus their pain by pointing at others (that’s a separate article, on the Blame Game, worth exploring soon).

We are all coping with the ambiguity of Auntie being here, yet not here. She is no longer resembling her true self as we knew her. Sometimes she is delirious, sometimes she is too weak to talk. As her body deteriorates, she is no longer living the full and robust life she once enjoyed.

This pain we are all experiencing has a name…it is called Ambiguous Loss. “Ambiguous loss is a loss that occurs without closure or understanding. This kind of loss leaves a person searching for answers, and thus complicates and delays the process of grieving, and often results in unresolved grief.” (Wikipedia)

There are a variety of types of ambiguous loss. One type is when people go missing and the body is never found. For example, a person does not return from a sailing trip, or from a hiking excursion, or war, or they are kidnapped. Their loved ones still feel a lack of closure because the body was not found. “Maybe they will return…” lingers in the mind.

After 9/11, all of us in NYC were processing personal and professional ambiguous loss for all of our New Yorkers who were lost in the pile of bodies that were never recovered.

Another kind of ambiguous loss is when people experience a new emotional boundary that hurts. This happens when people get divorced, or when someone ignores you, stops talking to you, shuts you out of their life. Any kind of break-up creates ambiguous loss, because the person is still here, yet not here. They are alive, but dead to you. This is considered more painful loss than when someone actually dies.

Medical illness and addictions cause ambiguous loss.

Ambiguous loss also occurs when a loved one has Altzheimers or dementia, and they no longer recognize social connections. Similarly, when someone is very ill, such as my Auntie, we have ambiguous loss because the illness is transforming our loved one into someone other than the person we always knew. We are mourning the living remnants of our loved one…so excruciating and bitter.

When someone is living with an addiction, this too causes their personal relations to deteriorate and they are not fully present for their loved ones. Again, they are here but not here.

I have a friend who had a beautiful daughter in Cambridge, MA, who chose to be homeless. Her daughter was an alcoholic. My friend tried all methods of intervention and help. Nothing worked. My friend suffered with ambiguous loss for so many years. Her daughter was a pianist, absolutely lovely. She died a few years ago, at 35, and it was one of the most heart wrenching tragedies I experienced. My friend is still recovering from this painful loss.

Learning to live a good life with ambiguous loss

I recently listened to a wonderful and insightful podcast interview with ambiguous loss pioneer Pauline Boss, Ph.D., who originally coined the term “ambiguous loss.” Krista Tippett hosts Dr. Boss on her podcast, On Being. You can listen here:

I prefer the unedited versions of Tippett’s interviews, because there are sometimes fascinating nuances that are deleted to make the long form interview fit into an hour. But I’m sure whichever one you listen to will be rewarding!

One of the ideas I took away from Dr. Boss’ talk was that we will never have complete closure from our ambiguous losses, or from our complicated grief. What we can do is become more adept at processing our negative feelings and difficult thoughts. Dr. Boss has some wonderful suggestions on the process.

Cognitive restructuring, which can be learned, is a big part of the solution. Dr. Boss’ stories and explanations are very helpful in deconstructing the different kinds of ambiguous loss that we all have in our lives.

Even though I learned about ambiguous loss and complicated grief in graduate school, it seems I keep deepening my learning about it more every year, from clients who are struggling with painful divorce, adult children with addictions, my Auntie’s battle with cancer, and for all the ongoing loss of freedoms in the world that never seems to subside.

Fun fact: Ambiguous loss is clearly part of our psychospiritual journey — for it forces us to grow and move to new levels of compassion and acceptance of things we cannot control. “Lack of power, that is our dilemma,” says Alcoholics Anonymous (Bill W., 1976). Yes, in our culture, we seek to control, cure, fix and manage everyone and everything as much as possible. We don’t like messy endings.

Yet what I have come to know, is that true mastery of life is being able to live in ambiguity with peace, even joy. My life is far from perfect…yet I am more often feeling positive, grateful, uplifted, inspired and anticipating good interventions that will transform it.

If we can learn to live in that “not knowing” place and be peaceful — that is a vast improvement on “hating ambiguity” and perhaps yelling at G-d or the Universe, or twisting into knots over why bad things do happen to good people…again, very messy, so annoying.

The truth is, when it comes to matters of love, there is no closure. As they say at the Grief Toolbox, “Closure is not part of the grieving process, nor is it necessary for healing. A connection formed in love can’t be closed.” Dr. Boss confirmed this with her years of research on ambiguous loss, leading to her forthcoming book on “The Myth of Closure.”

As Dr. Boss discussed in the interview, our Western culture wants neatly packaged endings and for everyone to move on as quickly as possible. There is plenty of shaming that goes on, as in “Aren’t you over that yet?”

Sadly, our culture does not tolerate ambiguous loss very well at all. It requires more Eastern, dialectical thinking. To be able to say non-binary statements such as “She is alive, but also dead,” “He is not here, but he is possibly still alive,” or “She looks like Auntie, but this is not Auntie anymore,” requires a leap from dualistic thinking to a more dialectical thinking which allows us to embrace opposite beliefs without sinking into a deep depression or disruptive anxiety vortex.

Solution Focused Suggestions

For today, I invite you to learn more about ambiguous loss, and start to apply these non-dualistic, non-binary, dialectical thinking ideas to your situation.

Listen to the podcast above, and learn some skills to help process your ambiguous grief.

Perhaps find a good therapist who can help you learn to cope better with your struggles. Good news: coping skills can be learned!

Learn to laugh at the absurdities, paradoxes and incongruities of life (Gavin, 2010; Wessan, 2013).

Practice your Distress Tolerance skills …join a Dialectical Behavior Therapy group. You may then find it easier to work through the painful moments, and allow yourself to live in ambiguity with, dare I say it, some joy!